Medicare

ICR 202206-3220-004

OMB: 3220-0082

Federal Form Document

Forms and Documents
Document
Name
Status
Form and Instruction
Unchanged
Form and Instruction
Unchanged
Justification for No Material/Nonsubstantive Change
2022-06-08
Supporting Statement A
2022-06-08
Supplementary Document
2021-06-29
Supplementary Document
2018-04-17
Supplementary Document
2015-01-08
Supplementary Document
2018-04-17
Supplementary Document
2015-01-08
IC Document Collections
ICR Details
3220-0082 202206-3220-004
Received in OIRA 202106-3220-003
RRB
Medicare
No material or nonsubstantive change to a currently approved collection   No
Regular 06/08/2022
  Requested Previously Approved
03/31/2025 03/31/2025
2,240 2,240
365 365
0 0

The Railroad Retirement Board administers the Medicare program for persons covered by the railroad retirement system. The forms in the collection obtain both information needed to enroll non-retired employees and survivor applicants in the plan and information from railroad employers needed to determine if a railroad retirement beneficiary is entitled to a special enrollment period when applying for supplemental medical coverage under Medicare.

US Code: 45 USC 231f(d) Name of Law: Railroad Retirement Act
  
None

Not associated with rulemaking

  86 FR 21362 04/22/2021
86 FR 34062 06/28/2021
No

  Total Request Previously Approved Change Due to New Statute Change Due to Agency Discretion Change Due to Adjustment in Estimate Change Due to Potential Violation of the PRA
Annual Number of Responses 2,240 2,240 0 0 0 0
Annual Time Burden (Hours) 365 365 0 0 0 0
Annual Cost Burden (Dollars) 0 0 0 0 0 0
No
No

$0
No
    Yes
    Yes
No
No
No
No
Brian Foster 312 751-4826 [email protected]

  No

On behalf of this Federal agency, I certify that the collection of information encompassed by this request complies with 5 CFR 1320.9 and the related provisions of 5 CFR 1320.8(b)(3).
The following is a summary of the topics, regarding the proposed collection of information, that the certification covers:
 
 
 
 
 
 
 
    (i) Why the information is being collected;
    (ii) Use of information;
    (iii) Burden estimate;
    (iv) Nature of response (voluntary, required for a benefit, or mandatory);
    (v) Nature and extent of confidentiality; and
    (vi) Need to display currently valid OMB control number;
 
 
 
If you are unable to certify compliance with any of these provisions, identify the item by leaving the box unchecked and explain the reason in the Supporting Statement.
06/08/2022


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